Patient Rights and Responsibilities

As a patient receiving services from a Sutter hospital, you should be aware of your rights and responsibilities, which are supported and protected by our care teams. When you are well informed, participate in treatment decisions, and communicate openly with your doctor and other health professionals, you help make your care as effective as possible.

Patient Rights and Grievance Process

View this American Sign Language video to learn about your patient rights and grievance process.

• To file a grievance: contact your local hospital or medical group.
• To file a complaint: contact the California Department of Public Health.

As a patient receiving services from a Sutter hospital, you should be aware of your rights and responsibilities, which are supported and protected by our care teams. When you are well informed, participate in treatment decisions, and communicate openly with your doctor and other health professionals, you help make your care as effective as possible.

Patients Rights

While you are a patient, you have the right to:

1. Considerate and respectful care, and to be made comfortable. You have the right to respect for your cultural, psychosocial, spiritual, and personal values, beliefs and preferences.
2. Have a family member (or other representative of your choosing) and your own physician notified promptly of your admission to the hospital.
3. Know the name of the licensed healthcare practitioner acting within the scope of his or her professional licensure who has primary responsibility for coordinating your care, and the names and professional relationships of physicians and non physicians who will see you.
4. Receive information about your health status, diagnosis, prognosis, course of treatment, prospects for recovery and outcomes of care (including unanticipated outcomes) in terms you can understand. You have the right to access your medical records. You will receive a separate “Notice of Privacy Practices” that explains your rights to access your records. You have the right to effective communication and to participate in the development and implementation of your plan of care. You have the right to participate in ethical questions that arise in the course of your care, including issues of conflict resolution, withholding resuscitative services, and forgoing or withdrawing life-sustaining treatment.
5. Make decisions regarding medical care and receive as much information about any proposed treatment or procedure as you may need in order to give informed consent or to refuse a course of treatment. Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved, alternate courses of treatment or nontreatment and the risks involved in each, and the name of the person who will carry out the procedure or treatment.
6. Request or refuse treatment, to the extent permitted by law. However, you do not have the right to demand inappropriate or medically unnecessary treatment or services. You have the right to leave the hospital even against the advice of members of the medical staff, to the extent permitted by law.
7. Be advised if the hospital/licensed healthcare practitioner acting within the scope of his or her professional licensure proposes to engage in or perform human experimentation affecting your care or treatment. You have the right to refuse to participate in such research projects.
8. Reasonable responses to any reasonable requests made for service.
9. Appropriate assessment and management of your pain, information about pain, pain relief measures and to participate in pain management decisions. You may request or reject the use of any or all modalities to relieve pain, including opiate medication, if you suffer from severe chronic intractable pain. The doctor may refuse to prescribe the opiate medication, but if so, must inform you that there are physicians who specialize in the treatment of pain with methods that include the use of opiates.
10. Formulate advance directives. This includes designating a decision maker if you become incapable of understanding a proposed treatment or become unable to communicate your wishes regarding care. Hospital staff and practitioners who provide care in the hospital shall comply with these directives. All patients’ rights apply to the person who has legal responsibility to make decisions regarding medical care on your behalf.
11. Have personal privacy respected. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. You have the right to be told the reason for the presence of any individual. You have the right to have visitors leave prior to an examination and when treatment issues are being discussed. Privacy curtains will be used in semi-private rooms.
12. Confidential treatment of all communications and records pertaining to your care and stay in the hospital. You will receive a separate “Notice of Privacy Practices” that explains your privacy rights in detail and how we may use and disclose your protected health information.
13. Receive care in a safe setting, free from mental, physical, sexual or verbal abuse and neglect, exploitation or harassment. You have the right to access protective and advocacy services including notifying government agencies of neglect or abuse.
14. Be free from restraints and seclusion of any form used as a means of coercion, discipline, convenience, or retaliation by staff.
15. Reasonable continuity of care and to know in advance the time and location of appointments as well as the identity of the persons providing the care.
16. Be informed by the physician, or a delegate of the physician, of continuing healthcare requirements and options following discharge from the hospital. You have the right to be involved in the development and implementation of your discharge plan. Upon your request, a friend or family member may be provided this information also.
17. Know which hospital rules and policies apply to your conduct while a patient.

18. Designate a support person as well as visitors of your choosing, if you have decision-making capacity, whether or not the visitor is related by blood, marriage or registered domestic partner status, unless:

    1. No visitors are allowed.
    2. The facility reasonably determines that the presence of a particular visitor would endanger the health or safety of a patient, a member of the health facility staff, or other visitor to the health facility, or would significantly disrupt the operations of the facility.
    3. You have told the health facility staff that you no longer want a particular person to visit.

    However, a health facility may establish reasonable restrictions upon visitation, including restrictions upon the hours of visitation and number of visitors. The health facility must inform you (or your support person, where appropriate) of your visitation rights, including any clinical restrictions or limitations. The health facility is not permitted to restrict, limit, or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation or disability.

19. Have your wishes considered, if you lack decision-making capacity, for the purposes of determining who may visit. The method of that consideration will comply with federal law and be disclosed in the hospital policy on visitation. At a minimum, the hospital shall include any persons living in your household and any support person pursuant to federal.
20. Examine and receive an explanation of the hospital’s bill regardless of the source of payment.
21. Exercise these rights without regard to, and be free of discrimination on the basis of sex, economic status, educational background, race, color, religion, ancestry, national origin, sexual orientation, gender, gender identity/expression, disability, medical condition, marital status, age, registered domestic partner status, genetic information, citizenship, primary language, immigration status (except as required by federal law) or the source of payment for care.

22. File a grievance. If you want to file a grievance with this hospital, you may do so by writing or by calling you local hospital or medical group.

    The grievance committee will review each grievance and provide you with a written response within 7 days. The written response will contain the name of a person to contact at the hospital, the steps taken to investigate the grievance, the results of the grievance process, and the date of completion of the grievance process. Concerns regarding quality of care or premature discharge will also be referred to the appropriate Utilization and Quality Control Peer Review Organization (PRO).

23. File a complaint with the California Department of Public Health regardless of whether you use the hospital’s grievance process. The California Department of Public Health’s phone number and address for each hospital is below.

    https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/FileAComplaint.aspx

24. File a complaint with the Department of Fair Employment and Housing at www.dfeh.ca.gov, 800-884-1684 or 800-700-2320 (TTY) or 2218 Kausen Dr., #100, Elk Grove, CA 95758.
25. File a complaint with the Medical Board of California at www.mbc.ca.gov/consumers/complaints, 800-633-2322 or 2005 Evergreen St., #1200, Sacramento, CA 95815.
26. File a complaint with The Joint Commission at: Office of Quality and Patient Safety, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181. 800-994-6610. www.jointcommission.org/report_a_complaint.aspx. Email: complaint@jointcommission.org

This Patient Rights document incorporates the requirements of The Joint Commission; Title 22, California Code of Regulations, Section 70707; Health and Safety Code Sections 1262.6, 1288.4, and 124960; and 42 C.F.R. Section 482.13 (Medicare Conditions of Participation).

Patient Responsibilities

To assist us in providing the quality of health care and services you expect and deserve, you, as a patient, have the responsibility to:

1. Provide, to the best of your knowledge, accurate and complete information about present complaints, medications, past illnesses, hospitalizations, and other matters relating to your health and healthcare.
2. Provide information about advance directives: give us direction about your preferences for future medical care and the identity of anyone who you may want to make healthcare decisions on your behalf should you later become incapable of making such decisions on your own.
3. Inform us if you do not understand a proposed course of action or what is expected of you.
4. Ask questions about your treatment, diagnosis and/or prognosis.
5. Partner with your care team on your plan of care.
6. Inform us immediately if you believe that you are given a medication or being provided with a treatment that is not correct or not intended for you.
7. Ask for pain relief when pain first begins. Help the staff assess your pain. Work with the staff to develop a pain management plan and advise staff if your pain is not relieved.
8. Use only the medications prescribed for you in the amount specified.
9. Report unexpected changes in your condition to a member of the staff.
10. Accept responsibility for your actions should you refuse treatment or should you choose not to follow the prescribed treatment plan.
11. Learn what you can do to improve your ability to care for yourself, if appropriate.
12. Follow hospital rules including those related to unit community living, noise control, smoking and visitors.
13. Respect the rights, privacy and confidentiality of other patients and staff.
14. Never bring a weapon into the hospital.
15. Never hurt or threaten another patient, family member or member of the staff.
16. Never bring alcohol or non-authorized drugs into the hospital.
17. Show your respect for the property of others and the hospital.
18. Leave your personal valuables and property at home.
19. Satisfy your financial obligations for care and treatment by providing us with correct information about your health insurance or other source of payment.
20. Talk with a member of the staff if you are dissatisfied with the care and/or service.